— Madeline, Florida There are many reasons why fluid can build up around the heart, a condition that is medically known as pericardial effusion. It is often associated with pericarditis, which is an inflammation of the pericardium, a double-layered membrane sac that surrounds the heart and protects it. One layer of the pericardial tissue is fibrous, connecting the heart to surrounding tissues; the other layer is serous, meaning it normally contains a small amount of pale yellow fluid that prevents friction as the heart pumps. Are you doing everything you can to manage your heart condition? Find out with our interactive checkup. Problems can arise when, for some reason, too much fluid starts to accumulate in this covering, also known as the pericardial lining. When that happens, the fluid can put pressure on the heart, affecting blood circulation and the body’s oxygen supply. Just to be clear, pericardial effusion and/or pericarditis are not the same as congestive heart failure, which people sometimes mistakenly describe as “fluid around the heart.” In congestive heart failure, fluid builds up in the lungs, causing the lungs to be heavy and making it difficult to breathe; in pericardial effusion or pericarditis, fluid builds up in the lining around the heart. Q2. My dad is 99 and will be 100 this year. His heart rate is slow, in the 54 to 40 range. It’s been like that for several years. It was stated that he has bradycardia. Do you think he should have a pacemaker at his age? What are the risks? Thank you! — Faye, California Even though your father is nearly 100 years old, there is no specific reason why he shouldn’t be able to get a pacemaker if he is otherwise healthy. A pacemaker can be a life-saving device in the event of heart failure, which is a risk for patients with slow heart rhythms (bradyarrythmias). Since your father has been diagnosed with bradycardia (a resting heart rate of fewer than 60 beats per minute), he could certainly be a candidate for a pacemaker, though it is not clear from your description whether his heart rate has been at that level for some time or if this is a more recent issue. Your father’s doctor can determine, based on his overall health and his specific heart condition, whether a pacemaker would be right for him. It would, of course, also be important for your father to have a cardiologic workup before considering a pacemaker to make sure that his body is capable of handling the surgery required to insert the device. Generally speaking, the insertion of a pacemaker is a safe procedure, but since your father is nearly 100 years old there are some additional risks involved, as there would be with any type of surgery at that age. Should he choose to go through with getting a pacemaker, it is important that your father seek out a very skilled and knowledgeable cardiologist and team who can monitor his health throughout the process. Learn more in the Everyday Health Heart Health Center. In fact, the most common cause of pericarditis is an idiopathic (or presumed) viral infection, which usually will go away on its own over time or with anti-inflammatory medications. Fluid buildup is also fairly common after heart surgery, related to a condition known as post-cardiotomy syndrome. Treatment for pericardial effusion and/or pericarditis will depend on the cause of the problem. Often the condition will resolve itself, sometimes the fluid can be drained with a needle, and medications may be an option as well.
